Image: NHS Lothian
The so-called “independent” review of maternity services chaired by Tory peer Baroness Cumberlege - which reports today - has predictably shown itself to be nothing more than a pretext for privatisation.
Its proposals would fragment an already over-stretched midwifery workforce, take vital funding away from mainstream maternity services, and potentially force more NHS maternity services to close or centralise, bringing more anguish to women who would have to travel further to give birth.
The proposal to fragment maternity services by giving pregnant women a £3,000 ‘personal budget’ to spend as they wish is indeed a formula for chaos and destabilising core maternity services. The obvious danger is that as women are given funding to spend as they wish on “one-to-one midwifery”, more and more midwives will be encouraged opt out of high-pressure work on busy maternity wards, and opt instead to offer services privately.
Baroness Cumberlege is one of a number of peers with financial interests in the chaotic privatising ‘reforms’ forced through under Tory Health Secretary Andrew Lansley.
Now she is advocating a policy that will effectively encourage small scale private provision of services for women with uncomplicated pregnancies, at the expense of the NHS provision for those with more complex needs.
It is bizarre to see that the Royal College of Midwives, which only four months ago was complaining that overstretched and under-staffed maternity units across the country were closing their doors for lack of staff, has for some reason welcomed these latest proposals. In the current climate of frozen and inadequate NHS funding, these plans can only make matters worse.
RCM chief Executive Cathy Warwick said she was ‘delighted’ with the plans, but went on to warn that more midwives would be needed – despite the fact that there would be no extra money in the pot to pay for any additional staff.
The proposal has all the disadvantages of other “personal budget” and “NHS voucher” schemes – in that it opens the way to individual “top-up” payments, widespread full-scale charging for health care, and private health insurance.
Like personal budgets it would take money from core budgets for services, without evidence or systems to ensure it will be spent appropriately – and leaving an under-resourced service to deal with all the more demanding cases – and those that develop later complications.
The NHS England statement explicitly says that any woman needing urgent care because of complications would get it regardless of whether their personal budget had been spent.
This policy is as illogical and unrealistic as the government claims that an NHS that is already billions in deficit, and facing cuts to balance the books, can implement 7-day working with no extra staff or funding.
In this case the main beneficiary is likely to be a newly created private sector midwifery service, run by NHS-trained midwives who might otherwise be delivering NHS care in NHS units or in the community, free of charge at point of use.